Hypertension Management & Outcomes: The Latest From ACC.25

Photo Credit: Ake Ngiamsanguan

A wealth of research is being presented at ACC.25, including new data on hypertension management and outcomes.

Standing Hypertension’s Link to Arterial Stiffness

One abstract reported that standing hypertension was associated with arterial stiffness in older adults.¹

“Standing hypertension, elevated blood pressure (BP) while standing, can predict adverse cardiovascular disease events,” said Molly Cole, MD, and colleagues.

The study included 166 community-dwelling veterans without known cardiovascular disease. The patients were an average 70.3 (±7.5) years of age, 28.3% were female, and 57.2% were taking medications for their BP.

Standing hypertension was defined as standing systolic BP (SBP) greater than 140 mm Hg. The researchers reported that 84 patients had standing hypertension (standing SBP, 154.7 [11.5] mm Hg) and 82 did not (standing SBP, 122.4 [10.5] mm Hg; P<0.001).

The participants underwent standing brachial BP measurements and 24-hour ambulatory BP monitoring. According to the findings, patients with standing hypertension had higher SBP on 24-hour ambulatory BP monitoring (126.6 [8.9] mm Hg vs 118.7 [11.6] mm Hg; P<0.001). These patients also had greater resting arterial stiffness, as measured by carotid-femoral pulse wave velocity (cfPWV) using tonometry.

Unadjusted models showed that greater cfPWV was associated with high standing SBP (β: 0.43; standard error [SE]: 0.07; P<0.001) and older age (β: 0.35; SE: 0.07; P<0.001). After adjusting for cardiovascular disease risk factors, the researchers found that standing SBP remained linked to cfPWV.

“Standing hypertension is associated with greater arterial stiffness in older adults, even in those with near optimal 24-hour ambulatory BP monitoring,” Dr. Cole and colleagues concluded.

Smart BP Monitor Use in Underserved Populations

To help clinicians bridge gaps in care, another abstract reported factors influencing smart blood pressure monitor (SBPM) uptake among Black and Latino older adults.²

“SBPMs are increasingly used among older adults, but low usage of SBPMs among African American and Latinx is concerning,” the researchers said. “Beyond sociodemographic factors, reasons for SBPMs use and non-use among minority older patients are not well understood. We aim to explore mutable factors related to SBPMs use through conducting an exploratory interview study.”

The researchers interviewed 20 English-speaking older adults who had hypertension and had been prescribed an SBPM. The participants were an average age of 70.7 years (mean=70.7; SD=10.3), and most were Black (n=19; 95%).

The study authors used the digital literacy framework and Andersen’s expanded model to identify the following psychosocial, enabling, and need factors:

• Psychosocial factors: SBPM use was associated with a positive attitude toward health monitoring and prior knowledge of health technology.
• Enabling factors: Patients were more willing to use SBPMs if they had a positive rapport with their clinicians and the device’s design was user friendly.
• Need factors: SBPM utilization improved if patients perceived them as essential for monitoring hypertension and underwent objective evaluations by clinicians.

Of note, financial concerns and physical limitations such as disabilities were barriers to SBPM utilization.

“Identifying these factors provides a starting point for clinicians to implement strategies to enhance utilization of SBPMs and other smart health devices among minority older adults, ensuring equitable access,” the authors concluded.

The researchers noted that they plan to conduct further research to understand the frequencies and significance of these factors.